Some Good Sleep Practices For All Types Of Insomnia

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1 10 Some Good Sleep Practices For All Types Of Insomnia There are some common lifestyle habits that may have an effect on sleep and should be mentioned in case they apply to you. This is a good time to look at your sleep diary. Caffeine How many times across the day did you have caffeine and at what times? Caffeine is a powerful stimulant that increases your alertness. The half-life of caffeine is about 6 hours in healthy individuals (longer for older people and people with insomnia). Therefore, if you have a cup of coffee at 4 p.m., half of the maximum stimulating effect is still there at 10 p.m. Therefore, it is best to avoid caffeine from the mid afternoon. That cup of tea or coffee after your evening meal will reduce your ability to fall asleep that night or, if it doesn t stop you from falling asleep, it may still lighten your sleep later in the night. It s easy to underestimate how much caffeine you actually have over a day. Don t forget that caffeine isn t only in the tea and coffee you drink but also in soft drinks such as colas, energy drinks, and certain over-the-counter medications. Chocolate and chocolate-flavoured drinks also have some caffeine. Reduce your overall caffeine intake and avoid it from mid afternoon onwards. However be aware that suddenly stopping caffeine intake can produce withdrawal symptoms such as headaches and lethargy. Gradually cutting back by one drink a day, starting with your last caffeine drink of the day, is the best way to do it. If you still prefer a hot drink, herbal infusion teas that specify no caffeine can be used as a pleasant alternative to caffeine drinks. Alcohol Alcohol has the opposite effect of caffeine it tends to have a sedative effect. Some people may use alcohol to help them fall asleep. However, after a few hours this effect wears off and withdrawal symptoms occur leading to disturbed sleep in the second half of the night. Alcohol also tends to suppress REM sleep in the early part of the night that can lead to vivid 39

2 dreams and sometimes nightmares in the second half of the night. Awakening from these vivid dreams can then be associated with anxiety and make it difficult to get back to sleep and actually contribute to the development of conditioned insomnia. Alcohol in the evening can also make you snore even if you don t usually snore and produce some sleep apnoea in those who normally snore. Overall, excessive alcohol (more than two standard drinks) is detrimental to your sleep. Nicotine Nicotine is also a stimulant and therefore may affect your sleep pattern. Avoid smoking just before bedtime or during a night-time awakening. Food Avoid a heavy meal within about three hours of your bedtime. If you do suffer from gastric reflux/heartburn at night, also avoid spicy meals. On the other hand, if you have an early evening meal, you may enjoy a light snack before bed rather than going to bed feeling hungry. Best to avoid sugar and chocolate in the snack. Exercise What time of the day do you normally exercise? Regular aerobic exercise (e.g. walk, jog, bike, swim), particularly in the late afternoon or early evening, can promote better quality and deeper sleep as well as provide many other health benefits. But avoid vigorous exercise just before bedtime. Instead, relaxing exercise such as yoga or stretching before bed may be beneficial. Before you go to bed at night: Establish a Routine before bedtime Having a relaxing routine before bed will encourage a better sleeping pattern. In the evening before going to bed, have an hour of relaxing activity under dim lighting no bright lights, no computers. Within that hour before bedtime, avoid doing work related activities or exciting activities such as playing computer games. Reading or watching television is recommended but remember no bright light (the only exception is for those with early morning awakening insomnia Chapter 8). Some people find that a hot bath before bed is not only relaxing but can ease them into a 40

3 deeper sleep. After the hot bath, our body temperature will then fall more rapidly which in turn promotes deeper sleep. Bedroom environment Usually no bedroom can be entirely free of noise or light. Most good sleepers aren t usually bothered by mild levels of noise and discomfort. Loud and unpredictable noises however can disturb your sleep. If external noises cannot be reduced (snoring partner, road noises, etc.), some comfortable earplugs can be helpful. A supportive mattress and pillow will ensure you are comfortable in bed. If you use an electric blanket to take off the winter chill, it may overheat you and disturb your sleep if you leave it on during the night. It is best to turn it off when you go to bed. What about a TV in the bedroom? It is a good idea to remove televisions or computers from the bedroom. Remember, we want to strengthen the association between bed and sleeping, not bed and watching TV or working on a computer or playing computer games. Also, these can be arousing, as can taking work or arguments to bed. Reading in bed? Many people find it is relaxing to read in bed. In fact, being unable to read that last sentence because your eyes are closing or you can t concentrate is often a cue to turn out your lights. However if you are the type of person who gets really engrossed in a book and can t put it down, then reading in bed is not a good idea for you. If you do read for a short while after going to bed, don t forget to use a dim reading light. A bright reading light every night can delay your body clock and make it take longer to fall asleep. What about the bedroom clock? Constantly checking the time during the night can trigger worry and concern about still being awake. This anxiety will inhibit sleep. If you tend to do this, turn the clock face away from you. Can I nap during the day? In some cultures people traditionally have a sleep (1-2 hours) during the day and the culture accommodates to that practice by shutting down commerce during that Siesta period. However, people in those cultures also stay up late and do not expect to get as much sleep at night. Their total sleep requirement is no different than in single nocturnal sleeping cultures, it is simply split between an early afternoon long nap and late nocturnal sleep. There is obviously nothing harmful about such a practice. However, if you are spending over 8 hours in bed at night hoping for solid sleep in that period, you are likely to be frustrated with periods of wakefulness in that 8 hour bed period if you are also obtaining 1-2 hours of sleep during the day. 41

4 But what about a brief power or nana nap during the day? Will that affect your nocturnal sleep. If you are feeling very sleepy during the day, a brief nap of approximately minutes can reduce that sleepiness for a few hours and make it easier to get through the rest of the day without decreasing your sleep pressure for night time sleep. It can also give you a bit of reassurance, if you are awake in the middle of the night, that you can have a brief nap the next day to help rejuvenate you. However, avoid daytime naps longer than 20 minutes. These can actually make you feel groggy and more tired for a while after the nap. A long daytime nap can also interfere with your sleep that night. So long daytime naps are not a good idea for people with insomnia. They may be contributing to your night time insomnia. Our Response to Noises in the Night The heavy snoring from one partner often affects the other. Snoring can sometimes be relieved by changing position from lying on the back to the side. If you think your partner may have Sleep Apnoea (Chapter 16) then a referral from your GP to a sleep clinic should be encouraged. Sometimes we emotionally react to noises we build up indignation and annoyance and even anger. You may feel that your annoyance and anger is justified for concern of the detrimental effects of the noise on your sleep and subsequent daytime tiredness. However, it is not so much the noise itself that affects our sleep, it is our reaction to the noise that has a greater detrimental effect. This reaction will trigger off the flight-or-flight biological response that will, in turn, increase alertness and prevent sleep. But in addition to the loss of night time sleep, feeling fatigued the next day also arises from activation of the fight-or-flight reaction during the night. It uses up our emergency response mechanism and the feelings of fatigue comes from the loss of that back-up mechanism. When your awake-in-the-middle-of-the-night brain blames a noise for being awake, recognise that is happening. Try to avoid wasting your emotional energy on something you can t control. Cognitive therapies (Chapter 13) and a relaxation technique (Chapter 14) will help distract you from becoming frustrated and angry.. 42

5 Specific strategies Now, apart from the life style issues mentioned above, the specific strategies below (Chapters 10-14) are most important for overcoming your type of sleeping difficulty and therefore improve the quality of your sleep and daytime feelings. 43